Department of Neonatology, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden.
Charité-Universitätsmedizin Berlin, Berlin, Germany.
JAMA Netw Open. 2024 Jun 3;7(6):e2417431. doi: 10.1001/jamanetworkopen.2024.17431.
Red blood cell (RBC) transfusion is a common medical intervention to treat anemia in very preterm neonates; however, best transfusion practices, such as thresholds, remain uncertain.
To develop recommendations for clinicians on the use of RBC transfusions in very preterm neonates.
An international steering committee reviewed evidence from a systematic review of 6 randomized clinical trials (RCTs) that compared high vs low hemoglobin-based or hematocrit-based transfusion thresholds. The steering committee reached consensus on certainty-of-evidence ratings and worked with a panel from stakeholder organizations on reviewing the evidence. With input from parent representatives and the stakeholder panel, the steering committee used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to develop recommendations.
A systematic review of 6 RCTs encompassing 3483 participants (1759 females [51.3%]; mean [SD] age range, 25.9-29.8 [1.5-3.0] weeks) was used as the basis of the recommendations. The ranges for higher hemoglobin concentration (liberal) vs lower hemoglobin concentration (restrictive) threshold study arms were similar across the trials. However, specific thresholds differed based on the severity of illness, which was defined using variable criteria in the trials. There was moderate certainty of evidence that low transfusion thresholds likely had little to no difference in important short-term and long-term outcomes. The recommended hemoglobin thresholds varied on the basis of postnatal week and respiratory support needs. At postnatal weeks 1, 2, and 3 or more, for neonates on respiratory support, the recommended thresholds were 11, 10, and 9 g/dL, respectively; for neonates on no or minimal respiratory support, the recommended thresholds were 10, 8.5, and 7 g/dL, respectively (to convert hemoglobin to grams per liter, multiply by 10.0).
This consensus statement recommends a restrictive RBC transfusion strategy, with moderate certainty of evidence, for preterm neonates with less than 30 weeks' gestation.
红细胞（RBC）输血是治疗极早产儿贫血的常见医疗干预措施；然而，最佳输血实践，如阈值，仍然不确定。
为临床医生制定极早产儿使用 RBC 输血的建议。
一个国际指导委员会审查了一项系统评价的证据，该系统评价比较了高 vs 低血红蛋白或红细胞压积为基础的输血阈值的 6 项随机临床试验（RCT）。指导委员会对证据确定性评级达成共识，并与利益相关者组织的一个小组一起审查证据。在家长代表和利益相关者小组的意见输入下，指导委员会使用分级评估、制定与评价（GRADE）方法制定建议。
作为建议的基础，使用了一项系统评价的 6 项 RCT，涵盖了 3483 名参与者（女性 1759 名[51.3%]；平均[SD]年龄范围，25.9-29.8[1.5-3.0]周）。在试验中，较高血红蛋白浓度（宽松）与较低血红蛋白浓度（限制）阈值研究臂的范围相似。然而，具体的阈值因疾病的严重程度而不同，这在试验中是使用不同的标准定义的。有中等确定性的证据表明，低输血阈值可能在重要的短期和长期结果上几乎没有差异。基于产后周数和呼吸支持需求，推荐的血红蛋白阈值有所不同。对于正在接受呼吸支持的新生儿，在产后第 1、2 和 3 周或更长时间，推荐的阈值分别为 11、10 和 9 g/dL；对于没有或仅需要最小呼吸支持的新生儿，推荐的阈值分别为 10、8.5 和 7 g/dL（将血红蛋白转换为克/升，乘以 10.0）。
这项共识声明建议，对于妊娠不足 30 周的早产儿，采用中等确定性证据的限制性 RBC 输血策略。
